Evidenced-Based Socialization Interventions for Children with ASD

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Evidenced-Based Socialization Interventions for
Children with ASD
Sunyoung Kim, M.Ed. Gregory Lyons, M.A.
University of Wisconsin Madison
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Why Improve Social Skills?

• Difficulties in social functioning
• Are a defining aspect of ASD (Kanner, 1943 APA,
  2000)
• Put individuals with autism at risk for social
  isolation, loneliness, delinquent behavior, low
  academic achievement, increase job loss, and
  mental health problems (Williams Asher, 1992
  Bauminger Kasari, 2000 Koegel Koegel, 1995
  Strain, 1991 )
• Up to 38 risk of developing comorbid diagnosis
  in depression in comparison to only 6.7 of the
  general population (Stewart, et. al., 2006
  NIMH.nih.gov/health/publications)
• Appropriate social development in peer
  interactions is critical for later adjustment,
  acceptance by others, and ones quality of life
  (Guralnick, 1990).
• Children with successful social interactions have
  a higher positive self-concept and self-esteem
  (Janney Snell, 2006)

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Evidence-Based Practices
Effective and Scientifically valid interventions
and Treatments (for students with ASD)

• Four Factors of evidence-based practice
• Research Findings
• Professional judgment
• Values and Preferences
• Capacity
• (National Autism Center, 2009)

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Importance of Evidenced-Based Practices?

• IDEA in 2004 require that evidence-based
  practices be used to ensure individuals with
  disabilities receive the highest quality
  instruction.

• No Child Left Behind (NCLB) requires that
  teacher use evidence-based practices in their
  classrooms.

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Established Treatments

• Antecedent Package
• Behavioral Package
• Comprehensive Behavioral Treatment for Young
  Children
• Joint Attention Intervention
• Video Modeling
• Naturalistic Teaching Strategies
• Peer Training Package
• Pivotal Response Treatment
• Schedules
• Self-Management
• Story-based Intervention Package
• (The National Autism Center, 2009)

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Two Evidenced-Based Interventions

• Video Modeling
• Naturalistic Behavior Interventions
• Pivotal Response Treatment

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Video-Modeling Intervention

• The interventions rely on an adult or peer
  providing a demonstration of the target behavior
  that should result in an imitation of the target
  behavior by a target child with ASD.
• VM involves a child watching videotapes of
  positive examples of adults, peers, or him- or
  her self engaging in a behavior that is being
  taught.
• (Haring, Kennedy, Adams Pitts-Conway,
  1987)

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The Rationales for using video-based instruction

• The observational learning is a basic learning
  mechanism.
• Visual perception abilities of individuals with
  autism are often seen as an area of strength.

• Motivation
• (Darden-Brunson et al., 2008
• Bellini and Akullian, 2007)

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VM Procedures

• 1. Identify and select target social behaviors
• Observable and measurable behaviors (e.g., saying
  hello to peers)
• 2. Interview parents and observe the child
• Formal or informal preference assessment
• 3. Select and train models
• Self-modeling and other-modeling
• Training by role-play
• 4. Record target behaviors and Edit the video
• Natural behaviors
• The duration of the video

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Procedure (Cont.)

• 5. Baseline
• Collect baseline data
• No video intervention
• 6. VM sessions show the video clip of desired
  behavior to the target child
• Refrain from adult direction
• Several sessions
• Identical setting to baseline
• Collect intervention data and graph data
• 7. Promote maintenance and generalization
• New settings, people or behaviors (Banda
  et al. 2007)

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What if my child does not attend to the video?

• Find a video the child likes, turn it on and play
  just a bit of it in order to get the childs
  attention
• Then before the child turns away, put on the
  video clip for the modeling intervention
• (HineWolery, 2006)

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Research/ the Effects of VM
Daily skills Setting a table, preparing orange juice, meal preparation, hanging a pant purchasing, brushing teeth. (Shipley-Benamou, Lutzker, Taubman, 2002)
Communication skills Spontaneous requesting, recognizing emotions in speech and facial expressions, complimenting-giving initiations and responses, language production, verbal responses to questions. (Buggey, 2005 Charlop-Christy et al. 2000
Social skills Play behaviors (reciprocal play, play related comments, socio-dramatic play), complying, greeting, and chasing, spontaneous greeting, social initiation. (Nikopolus Keenan, 2004)
Academic skills Generative spelling (Kinney, Vedora, Stromer, 2003)
Challenging behaviors Aggressive pushing and tantrums (Buggey, 2005)
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Research

• DAteno, Mangiapanello, and Taylor (2003)
• Adult modeled video intervention to teach complex
  interactive play sequences to a preschooler with
  autism.
• A 3 years-old girl learned to use scripted and
  non-scripted play sequences, including verbal
  social commenting on the play (e.g., come on
  drink the tea) and actual play actions (e.g.,
  placing plates on the table or pouring tea).

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Example Evidence
Using video modeling to teach complex play
sequences to a preschooler with autism (D'Ateno,
Mangiapanello Taylor, 2003)
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Example Evidence
Using video modeling to teach reciprocal pretend
play to children with autism (MacDonald et al.
2009)
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Strengths

• Convenience for parents and teachers because
  recorded video-taped can be reused.
• Systemic and controlled, as the video scenario
  can be rehearsed and re-recorded until the
  behavior of the model is to an acceptable
  standard.
• Time and cost effective.
• (Bourdeau DEntremont, 2010)

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Case Example Turn Taking
Procedure Example
Identifying Target behavior Turn taking, specifically saying my turn prior to taking a turn during toy play (in 5 mins play sessions)
Interview parents and observe the child Make sure the target child likes to watch TV, through the Parents' interview and observation.
Select and train models Familiar adult models (e.g., two teachers)
Record target behaviors and Edit the video Decide the length of the video Record target behaviors and edit the video
Baseline collect baseline data Without prompts or reinforcement Several sessions
VM sessions Show the video to the target child before play (video) Several sessions Refrain from adult direction Limited number of players Collect intervention data and graph data
Promote Maintenance and generalization Generalize to new games, settings and players.
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Naturalistic Behavior Interventions
Less Natural
More Natural
Not structured, little interference by a mediator
or facilitator, purely contextualized (e.g.,
developmental-relationship based models)
Highly structured and decontextualized (e.g.,
some programs in DTT)
Naturalistic Behavior Interventions

• Utilizes principles of Applied Behavior Analysis
• Natural environments and contexts (examples?)
• Natural rewards
• Natural activities
• Peer-mediated
• Promotes generalization/maintenance
• Pivotal Response Treatment
• Focus on motivation to use the target social
  skills/goals
• Prioritizes certain ABA techniques
• Developmentally Sensitive

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Research Base
Pivotal Response Treatment
(peer-mediated packages) Pierce Schreibman,
(1995) Pierce Schreibman, (1997) Pierce
Schreibman, (1997) Harper, Symon, Frea study
(2008) PRT w. Contextually Supported-Play
Dates Koegel, Werner, Vismara, Koegel
(2005) Peer-mediated incidental teaching Mcgee
et al. (1992) Incorporating Special
Child-Interests at Recess Baker, Koegel,
Koegel (1998) Baker (2000) Licciardello et al.,
2008 Boyd, Conroy, Mancil, Nakao, Alter
(2007) Shafer et al. adding preferred to
recess Priming Play Zanolli et al. (1996)
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Global Socialization Objectives

• Increase length of time engaged with peers
• Increase variety of activities engaged with peers
• Increase responsivity toward peers
• Increase initiations toward peers (e.g., play
  invitations, greetings)
• Increase frequency and variety of communicative
  behaviors
• behavior regulation (e.g., requesting)
• question-asking
• joint attention (e.g., commenting on the
  play/toy)
• conversation
• Pragmatics (nonverbal social skills)
• Goals should be individualized and developed
  collaboratively with and coordinated with
  caregivers.

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Overview of Pivotal Response Treatment

• Principles
• Based upon the principles of Applied Behavior
  Analysis (ABA)
• Implemented in the natural environment within
  daily routine
• Improvements in untargeted areas (pivotal areas)
• Parent education model
• Pivotal Areas
• Motivation
• Responsivity to Multiple Cues
• Self-management
• Self-initiations

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Motivation PRT Points

• When improving an individuals motivation to
  acquire new socialization, conversation, and
  behavior skills
• Point 1 Obtain individuals attention first
• Point 2 Intersperse acquisition tasks among
  maintenance tasks
• Point 3 Provide choices follow individuals
  choice in activity/stimuli
• Point 4 Responsivity to multiple cues
• Point 5 Reinforcement contingent upon individual
  exhibiting target behavior
• Point 6 Reinforce attempts
• Point 7 Use direct and natural reinforcers

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Antecedent
Behavior
Consequence
B
A
C
Opportunity presented
Child responds
Response reinforced

• Contingent
• Reinforce attempts
• Direct and natural reinforcers

• Child attention/Clear cues
• Maintenance tasks
• Child choice/ Shared control

• Depends on
• Target Goals
• Context/activity
• Maintenance/
• Acquisition balance

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Antecedent
Behavior
Consequence
B
A
C
Opportunity presented
Child responds
Response reinforced

• Peer
• Child attention/Clear cues
• Maintenance tasks
• Child choice/ Shared control

• Peer
• Contingent
• Reinforce attempts
• Direct and natural reinforcers

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Peer Mediation

• Explicit instruction
• Modeling
• Performance feedback (primarily positive)
• Use child-friendly language.

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• Make sure child with ASD is attending to the
  person speaking to him/her (may have to say the
  childs name, tap shoulder, interrupt play)
• The opportunity to respond (model-prompt,
  instruction, question, choice, time delay) should
  be
• Clear
• Appropriate to the task
• Uninterrupted
• Child must be attending

Training peers Be sure peers know ways to gain
childs attention (e.g., Nicky, ask your brother
which color he wants, but make sure hes looking
first by saying his name. Wow Eli, I really
like how you got Taj to look at your first!)
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• Make sure maintenance verbalizations are
  interspersed with acquisition verbalizations
• At first, the acquisition for children will
  be the socialization, and opportunities should be
  set up where child will be successful as often as
  possible
• Vary what types of verbalizations child with ASD
  is using to prevent overgeneralization or boredom
• Vary antecedents (e.g., types of opportunities)
• - Types of opportunities
• Model-prompts, directives, choices, open-ended
  questions, leading statements, time delays

Training peers Peers may need on-going coaching
on what opportunities to provide. Step in when
needed and remind peers to talk about different
things OR provide models on how to give different
types of opportunities OR a reminder to make sure
they are asking their peers easy questions too.
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• Child directed
• Follow childs lead
• Shared control
• Provide choices

• Child directed
• Follow childs lead
• Shared control
• Provide choices

• Training peers- Peers can be instructed to give
  children
• - choices in activities to play
• - follow and see what the child wants to do (What
  does it look like Jay wants to play?)
• - give children choices as an opportunity during
  an activity (e.g., do you want 5 pieces or 2
  pieces?).
• gain shared control- Remember to have the piece
  in your hand before you get his attention and ask
  him that. Wow, I like how you stopped the swing
  before you asked him if he wanted to go high or
  low!
• Create Cooperative Arrangements

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• Reinforcement contingent upon desired child
  behavior
• Immediate
• Appropriate
• Dependent

Training peers Remember, if your friend Sally
needs help opening her snack, wait for her to ask
for your help first. I like how you asked Taj a
question! Next time remember to wait to hand him
a card until he answers your question. Wow,
youre fast! Im impressed how you chased Jay
when he asked you chase him down the hill!
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• Increase motivation to respond
• Reasonable attempt
• Attention to the task
• Related to the task
• Intent to respond

Training peers Remember, Sally is still
learning to talk with friends, so if she tries to
ask you to play on the swing, lets go play on
the swing with her.
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• Natural consequence
• Directly related to the behavior
• Functionally related to the behavior
• Generalization to the natural environment

Training peers This will naturally fall into
place. Wow, youre fast! Im impressed how you
chased Jay when he asked you chase him down the
hill! Wow! When Taj tried to ask you for a
turn, you gave her a turn! I like how you
offered Sally a seat next to you to share a
snack, when she asked you what you are eating!
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PRT for Socialization

• Follow the childs lead (i.e., target child
  chooses which game/toy to play with peer)
• Intersperse maintenance behavior regulation
  initiations (previously mastered
  requests/directives/protests) among acquisition
  (new requests/directives/protests) behavior
  regulation initiations
• Vary the task to maintain the childs interest
• Provide direct and natural reinforcers directly
  related to the childs behavior (e.g.,
  opportunity to obtain a game piece following
  initiation toward peer)

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Example Procedure

• Child w/ autism chooses game/activity
• Game/toy pieces divided between children or
  placed in see-through containers for shared
  control
• Child w/ autism prompted to make a behavior
  regulation initiation toward peer (e.g., Tell
  your friend which color you want.) or peer
  prompted to get attention clearly ask the child
  the child a question.
• After making behavior regulation initiation,
  target child contingently reinforced with natural
  reinforcers (e.g., requested color) by peer
• If necessary, peer prompted by clinician to
  provide target child with natural reinforcer
  (e.g., requested color)
• Sequence repeated as much as necessary
• Prompting faded as quickly as possible

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Creating a Social Context

• Contextually supported interactions- provides a
  context for
• Cooperative Arrangements
• Mutually reinforcing activities
• Where?
• - Playdates, recess on playground, recess in a
  class, neighborhood park, ice cream shop

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Cooperative Arrangements(cooperative
contingencies)

• Structure the activity/game so participation of
  each individual is critical to developing a
  positive outcome
• This strategy is necessary for shared control,
  gaining child attention, and using natural
  reinforcers
• Find activities that create interdependency- how
  do I structure an activity so that one kid will
  need the other kid in order for reinforcement to
  occur?
• How its done
• Use toys/games/activities with multiple pieces
• Divide pieces in container and take turns
• Take turns and share the items

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Mutually Reinforcing Activities

• Activities that both child with ASD and typical
  peer/siblings both find motivating
• How its done
• Observe what typical peers play and do
• Assess what games and activities child with ASD
  enjoys
• Provide choices during play episode (2 3
  choices)
• Child with ASD has final say
• Be discrete
• Take turns

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Cooperative Arrangements Examples
Location Activity
Playground -Catch with a ball -Friends pushing each other on a swing -Follow the leader -Hide and Seek
Art -Ask a friend rule
Lunch -Bring in preferred games and puzzles and separate the pieces out -Tag -Duck, duck, goose -What time is it Mr. Fox
Play Date Bowling Before the friend 1 bowls, friend 2 guesses how many pins friend 1 will knock down Make brownies One friend cracks the egg, the other pours in the oil, they count the number of stirs for each other
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Now its Your TurnBrainstorm how to make these
a Cooperative Arrangement
Activity Cooperative Arrangement
Children playing with cars on the floor
Swimming in the pool
Drawing
Running (hint think of different types of races)
Driving in the car
Frosting cookies
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General GuidelinesCooperative Arrangments
MRAs

• Child with ASD should be familiar with
  game/activity
• Limit to 2 3 peers
• Create cooperative arrangements
• Explain rules to ALL kids (e.g., Were going to
  practice paying nicely and take turns asking each
  other for pieces)
• Be sure child with ASD has opportunities to
  respond as well as initiate
• Give feedback to ALL the kids
• Have typically developing peers also practice
  responding and initiating to each other

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General Guidelines Continued

• Initially focus on opportunities for behavior
  regulation (requesting) intersperse some
  opportunities for social interaction and joint
  attention statements if appropriate
• Be sure to have kids respond to each other
  immediately as well as immediately deliver
  natural reinforcers (prompt if necessary)
• Practice both telling and asking
• Use colloquial speech
• Systematically fade prompting
• Initially may need to prompt both child with ASD
  and peers
• Initially start with model-prompt for entire
  utterance
• Quickly fade to partial verbal prompts, gestural
  prompts, time delays
• Make it short at first

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Summary

• How you can choose evidence-based practices.
• Two ways to teach and motivate your child to
  learn and use social skills.
• We saw this through..
• Showing your child video models of social skills
• Setting up PRT opportunities within contextually
  supported interaction with peers.

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Thank you!

• We would like to thank Dr. Wendy Machalicek for
  her guidance.
• For ongoing presentations on recent advances in
  autism research (RADAR), please visit
• uwradar.wordpress.com
• Also, for more information on Pivotal Response
  Treatment
• www.education.ucsb.edu/autism